Thursday, June 7, 2012

Depression When Weaning?

Although postpartum depression and other mood disorders are not talked about enough and still remain one of the most stigmatized issues in mental health care- depression within other stages of motherhood, such as breastfeeding, are talked about even less.  I'm going to specifically address depression and anxiety symptoms related to weaning a breastfed child.  I am going to utilize the term breastfeeding for the majority of this post, but I want to be clear that the act of lactating regardless of method of feeding can be coupled with these symptoms.  So mom's who pump can also experience this.

Weaning is the process that the mother and child participate in to ultimately stop breastfeeding.  Weaning occurs over a wide variety of ages.  In the US about half of babies are reported to be weaned by the age of 6 months, with the majority weaned by 1 year (more breastfeeding statistics).  Now some professionals have been increasing the length of time they consider a woman "postpartum", and consequently labeling the emergence of depressive symptoms in a woman up to 1 year postpartum as "postpartum depression".  I do not agree with this, and also want to make the distinction between a "postpartum depression" and "post-weaning depression".  Much like the postpartum "baby blues", there is a widely accepted "weaning blues" that occurs.  But these symptoms are short lived and include mild tearfulness and sadness.

Symptoms of Post-Weaning Depression and Anxiety:

  • Overwhelming feelings of sadness, hopelessness.
  • Feeling tired, fatigued
  • Insomnia or marathon sleeping
  • Lack of desire to do things you normally enjoy
  • Negative thoughts (ex. thinking you have failed as mother, your child deserves someone better)
  • Overwhelming worrying, fear
  • Feeling on edge, nervous
  • Thoughts about harming yourself 

During the lactation period (a time when a woman makes milk for nursing or pumping), women experience a plethora of hormone changes.  Lactating, much like the "natural high" some women experience after birth of their baby, causes the release of oxytocin and prolactin.  Oxytocin is a bonding hormone and some professionals believe this hormone may been involved in mood changes with lactating.  If you have high levels of oxytocin during breastfeeding, then weaning with create a drop in oxytocin.  This coupled with the loss of a "special" bonding time with your child may be the main culprit to the symptoms of depression and anxiety.  Or this shift in hormones may trigger those predisposed to experience depression.  Prolactin brings about feelings of calmness and relaxation.  Both Oxytocin and Prolactin dropping quickly can cause more severe symptoms.

Moms who never breastfeed may feel the effects of weaning right after the postpartum period- Although a milk supply can not be maintained without stimulation from a baby, milk/colostrum production still begin and a whole lot of hormone changes happen at once during this time.

In a wonderful blog post on Joanna Goddard's A Cup of Jo, Joanna graciously shares her personal experience with weaning her son.  Joanna is a bright and articulate mother who opens up about the sudden and debilitating effects her weaning depression and anxiety had on her.  Joanna shares about these difficult 6-weeks and touches on one of hallmarkers of the "disease of depression".  She writes:
Depression is something that often isn't completely recognizable by the person experiencing it until there is some relief or return to normalcy.  Joanna shares about waking up one morning and the doom and gloom was gone, over.  It was as if her body had returned to it's previous hormone levels, or at least had become accustom to the hormone changes.  Unfortunately not all women experience a relief from the depression without treatment, but as with postpartum depression and mood disorders, depression and anxiety with weaning is very treatable and women do get better. Following Joanna's blog, the Huffington Post wrote about post-weaning depression.

So who is at risk for feeling symptoms of depression and/or anxiety from weaning?  Women with a personal or family history of depression and mood disorders, especially a history of Postpartum Depression or another mood disorder.  But still women can experience these symptoms without any history at all- it seems that some women's body's are some sensitive the the hormonal shifts that take place during weaning.  Now weaning isn't only about emotions, it's also causes physical changes and some discomfort.  Kelly Mom (what I and many other mothers consider to be THE resource for breastfeeding moms on the web) shares how to cope with the physical stuff as well as a bit on the depression I wrote about.

How do you protect yourself or manage symptoms if they do occur?  Make mindful choices about when and how to wean to reduce discomfort.  Are both you and your child ready?  Examine your intentions, what do you hope to gain from weaning?  More freedom, preparing for another pregnancy, not enjoying the experience, child self weaning?  Enlist support from your partner, family, and other mom friends.  Know that you aren't alone if you feel tired, or sad in the beginning.

Based on the theory that the dramatic and fast change in Prolactin and Oxytocin contribute to the feelings of depression and anxiety, a gradual and slow weaning process may be best.

But weaning occurs for a variety of reasons- some women aren't able to make the choice to wean slowly or gradually on their own time.  Whether it's do to a medical condition, medication, lifestyle change, or advised by a physician.  Being told to wean when you aren't completely ready adds another layer to the process.

When to seek help? Always seek professional help if the symptoms are intense enough to impact your daily life.  Are you not sleeping well, or are you wanting to sleep all the time?  Do you feel tired, are you unable to maintain the same activities, hobbies, going to work?  Do others notice changes and comment on them? Do you question if you are a good mother?  Do you have thoughts about harming yourself or your child?

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